HomeMy WebLinkAboutAFTER THE FACT - SWG As-Built - 8/29/2023 AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION
Owner Name pi TD.i=i/(.f/ rc L$% Assessor Parcel# 1.3 Z`f 3 3//V - 31� -7c Szx
Mailing Address /%"" Clce2)01 ✓. . O/M Specialist Name ,�)/trf i"-' (
City, State. Zip wol (N,.'-c✓ee-tc C4-c115' Installer Name //N 1000p.irk
Site Address 5tel ei ?'f6(0 Al Nd)/1/C( Designer Name ON KA)ch"'✓1
Please complete this checklist to the best of your knowledge. If items are unknown leave blank.
INSTALLATION CHECKLIST
System Type (7KA✓+ Ij_ Pretreatment Type /N c,� L
Drainfield Ln. Ft. /0 ..c(I Drainfield Sq.Ft. Drainfield depth /8- 2 y ,.
>5 ft.from foundation? - -& c W W-t WA tREs ❑ NO
>50 ft.from wells? - ' ❑
z >50 ft.from surface water? - Lk-SE-�0 b L i2,3- �LLLd tg. El
HCleanout between building and tank? - - ❑ ❑
V Tank baffles present? - By=— -- --gig—ow-12 ❑
1:-: 24°access risers over each compartment?- - El ID
` tW Effluent filter installed?- - ❑ ❑ PC
Septic tank size c-)C( gal Manufacturer U KAcb«i1
0 D-box water level and speed levelers used? - - ❑ WA ❑YES -l'lo
oo� Manifold/D-box accessible from surface?- - 0 Ei 0
oa Check valves installed? - - El rl-
2 Transport Line Size A i''7 R 4-, Schedule/Class 6MKNrnNvt
0 Bedrooms installed (if known) ❑2 ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other AJOAJ -
>10 ft.from foundation?- - NIA ❑yes ❑ No
o >100 ft.from wells?- - ❑ ❑ X
W >100 ft. from surface water?- • - ❑ ❑ 14 .
LT >10 ft.from potable water lines?- - ❑ X ❑
Farr >5 ft.from property lines and easements?- - 0
OC >30 ft.from downgradient curtain/foundation drains?- - .: 0 El❑
clt
Observation ports present? - - ❑ ❑ .-
❑ Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ i,d ❑
Pump tank setbacks consistent with septic tank?- - ❑ WA ❑ YES ❑ No
Pump tank size gal Manufacturer
Q24'access riser(s)and accessible from surface?- - 0 ❑ 0
dAlarm or Control Panel Installed? -- ' --- ❑ 0 ❑
Control Panel equipped with Timer ' /C ter-•----- - - -- ❑ ❑ ❑
EL Pump installed in ❑ Bucket or ❑ • : . or Other
fl Pump Make/Model
El Floats or El Transducer
aTank draw down in/min Pump capacity qpm Squirt Height ft
Pump on time Pump off time Daily flow set at qpd
Updated 2/2201e
AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel# 3'Z4:1 3q- 4-f �7W7 C-
RECORD DRAWING •
tkDrainfietd&manifold P �64. 19 - —1jk R��� W In
►Il
orientation&layout 1 ' r
wddlmensions for '
re-location. .'siL V / i 1 a• n
121 Trenchlbed 't I I ' L'JC
dimensions and (c i i '
critical distances —
wiUunlayout ' i ; •• '
II r '
ISeptic/pump tank 1 / / ,
°cation w/dimen- I _
sions for re-location ' L A/
Location of buildings 36, _�� 3
existing/proposed ��
❑ Observation ports,
dean-out locations, 40
&manifotds/d-boxes I'' to
Pjr Location of wells, r 7
surface water,roads
&waterlines. , a.❑ Reserve area(s) --- -- �11 r �I
IANorth Arrow LDOY 7)/4(!) 1="(Fai___---__— n.
\ U. I!
1/ cki (DrarmJ g0C1C C-(ear,
Ville✓e !v Q,_ 011 TYcNcf"
/
� C,
1
cp im trio,c.oC14'--(o ►-�
O j
CO
If needed drawing may be attached on a separate page No.Pages Attached
CERTIFICATION OF INSTALLATION
DESIGNER/APPROVED O/M SPECIALIST
I certify that the infomation contained in this document is accurate to my knowledge. The drawing and information
has be ta• a rough common locating practices.
e) -a —Z 3
or/Approved O/M Specialist Dale
MASON COUNTY PUBLIC HEALTH
This is an after the fact record drawing, which may or may not include a county inspection. This information is to only
document an existing OSS location and components.
Signature of Environmental Health Specialist Date
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE '"ed 2g2"20I6